part c system georgia itca fiscal initiative cohort 1 2014

Part C SystemGeorgia

ITCA Fiscal Initiative Cohort 12014

Babies Can’t Wait• Georgia Department

of Public Health

• 18 Public health districts cover 159 counties

• Georgia’s birth – three population: 406,969

Georgia's Fiscal Structure Presented by: Dionne Denson, Deputy Chief Financial Officer

Service Delivery ModelPresented by: Phyllis Turner, Part C Coordinator (Acting)

Data SystemsPresented by: Tiffany Fowles, Senior MCH Epidemiologist

Challenges Presented by: Beverly Stanley, Deputy MCH Director

Current InitiativesPresented by: Phyllis Turner, Part C Coordinator (Acting)

Georgia’s Funding Model

Federal- PART C

$14,618,917 , 52%

State Funds

$9,140,982 , 32%

Title V Funds; 2984911; 11%

Medicaid Funds; 1493222; 5%

Private Insurance; $50,754 ; 0.18%

Client Fees; $2,771 ; 0.01%

Program Cost Drivers• Special Instruction

– Non-Reimbursable – Heavy reliance in rural area

• Increasing Caseload– 1.27% in federal fiscal year

2008 to 1.85% in federal fiscal year 2012

• Service Coordination– Traditional Fee-for-Service

(FFS) reimbursement only

• Low Care Management Organization (CMO) Enrollment– Results in over

utilization of the special instruction

– No CMO coverage for service coordination.

2007 2008 2009 2010 2011 20120

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

11,181 11,432 11,947 12,14813,607

14,143

BCW Statewide Cumulative Count

Child C

ount

Caseload by Fund Source

FFS Med-icaid27%

CMO44%

Private Insur-ance29%

Georgia’s Service Delivery Model

• Primary Service Provider (PSP) model – Strong reliance on teaming

• Teams composed of public and private providers– Weekly or bi-weekly meetings

• 99% of services delivered in natural environment

Data Systems

• BIBS (Babies Information and Billing System) database– Contracted service cost

• Uniform Accounting System (UAS) – Used to manage local level (district) cost for

infrastructure cost, and private (employee) providers

Data System-BIBSProvider Account Management

Authorized IFSP

services

Claims Data

Payment History

Ad Hoc Reports1. Assistive Technology

(AT) Expense by District

2. All Claims-claims which have completed the payment process cycle

3. Claims Awaiting Update-claims which have not completed the process cycle




ChallengesPresented by: Beverly Stanley, Deputy MCH Director


Challenges• Decrease in federal funds (↓ 9% for current fiscal

year)

• Flat State funds

• Significantly increased caseload

• Lack of Medicaid CMO reimbursement for Service Coordination - approximately 34% of the direct services cost for FFY 12

• Lack of Medicaid reimbursement for Special Instruction - approximately 22% of direct service cost for FFY12

Challenges - CMO

• Low CMO provider enrollment in certain areas due to complex, lengthy CMO enrollment processes

• Provider dissatisfaction with CMO reimbursement rates

• Over utilization of special instruction ( due to low

provider enrollment) at significant cost to the program

• Delays in obtaining physician prescriptions and

CMO authorizations for payment of Part C services impacts the ability of local programs to meet IFSP timeliness and timely service delivery requirements

Challenges

In FFY 2012 experienced fiscal challenges due to:

• Ongoing cost of provider positions previously funded by ARRA

• Challenges with Medicaid provider/District enrollment

• Lengthy delays in Medicaid fund recovery

Challenges

• In January 2013, state changed to a provider “chase and pay” system of reimbursement; BCW only pays:– After provider claims are billed and denied by

other funding sources– When BCW funds are the only payment source

for a service such as special instruction

• Third party fund recovery is no longer a function of the state data and billing system.

Current Initiatives - Taskforce• BCW Strategic Taskforce: A statewide group of

internal and external stakeholders organized in Fall 2013 – Define a high quality BCW program that is

fiscally responsible with long-term financial stability

– Improve provider relations– Reduce duplication– Establish efficient use of resources– Develop public relations campaign

Current Initiatives - Taskforce• Three committees developed – Administration– Service Delivery– Finance

• Recommendations to DPH Commissioner

• Ongoing implementation of recommendations

Current Initiatives - Other• Medicaid: Working with Medicaid to improve

provider enrollment and reimbursement • Standing weekly conference calls with the state’s

vendor for BIBS

• Dedicated state fiscal resource for BCW

QUESTIONS

part c system georgia itca fiscal initiative cohort 1 2014

Documents